Determinants of Cervical Cancer Screening in Ghana: A Systematic Review

Cervical cancer remains one of the leading causes of cancer-related deaths among women globally, despite being largely preventable through effective screening and early treatment (Castle, 2024). According to the World Health Organization (WHO), about 660,000 new cases and 350,000 deaths from cervical cancer were recorded in 2022 alone (World Health Organization, 2024). According to the report, the majority of these cases and deaths occurred in low- and middle-income countries (LMICs). Persistent infection with high-risk strains of the human papillomavirus (HPV) is the primary cause of cervical cancer. While developed countries have significantly reduced cervical cancer incidence and mortality through organized screening programs and HPV vaccination (Chan et al., 2019), many LMICs continue to face a high disease burden due to limited access to these preventive measures (Petersen et al., 2022). Sub-Saharan Africa (SSA), in particular, bears a disproportionate share of the global cervical cancer burden with the region recording some of the highest incidence and mortality rates worldwide (Dzinamarira et al., 2023). This may be due to factors such as inadequate healthcare infrastructure, low public awareness, limited trained personnel, and competing health priorities. Many women in SSA present with advanced-stage disease, often as a result of delayed diagnosis and lack of routine screening services (Atnafu et al., 2024). Despite global calls for cervical cancer elimination, most countries in SSA struggle with implementation of widespread, sustainable screening and HPV vaccination programs (Asangbeh-Kerman et al., 2022; Waheed et al., 2023). In Ghana, cervical cancer is the second most common cancer among women, following breast cancer (Daniels et al., 2024). This makes it a significant contributor to cancer-related morbidity and mortality in the country. According to estimates, Ghana reports over 2,700 new cases and approximately 1,700 deaths due to cervical cancer yearly (Effah et al., 2022). Despite these alarming statistics, screening uptake remains critically low in Ghana (Effah et al., 2023). Estimates suggest that fewer than 10% of eligible women have ever been screened (Awua et al., 2018). Although visual inspection with acetic acid (VIA), Pap smears, and HPV testing are available in some facilities in Ghana, very few women have ever screened, especially those living in rural areas (Appiah et al., 2025). National screening programs remain underdeveloped (World Health Organization, 2021) and although the HPV vaccine has been introduced in Ghana, anecdotal evidence suggests that nationwide coverage is still lacking. While similar challenges have been documented across sub-Saharan Africa and other African countries, evidence suggests that the determinants of screening uptake are highly context-specific. For example, a systematic review in sub-Saharan Africa identified barriers such as fear of the procedure, limited knowledge, distance to facilities, and negative experiences with healthcare providers (Lim & Ojo, 2017). A broader review across Africa found consistent challenges, including cultural beliefs, low awareness, human resource shortages, and lack of equipment (Mantula et al., 2024). However, the influence of these factors varied by setting. Country-level reviews support this variability. In Uganda, a systematic review by Black et al. (2019) showed that provider recommendation played a key role in encouraging screening. In the same review, rural residence, fear, and embarrassment were major barriers. In Nigeria, another review identified lack of knowledge, financial constraints, and misconceptions about the necessity of screening as dominant factors (Mafiana et al., 2022). These findings show that while some barriers recur across the continent, their impact and interactions differ depending on the local context. Factors such as healthcare infrastructure, sociocultural norms, and education systems in individual countries may be contributing factors to these differences. Given these differences, a Ghana-focused systematic review is urgently needed to capture the unique combination of factors that influence screening behaviors in this setting. Various primary studies have explored cervical cancer screening in Ghana. However, no comprehensive synthesis has been conducted to examine the full range of determinants. Without this, it is difficult to identify knowledge gaps, develop targeted interventions, or inform evidence-based policy. A country-specific review is also essential to support Ghana’s efforts to achieve the World Health Organization’s elimination goals and the Sustainable Development Goal 3.4, which aims to reduce premature mortality from non-communicable diseases. This systematic review therefore aims to examine and synthesize existing evidence on the factors influencing cervical cancer screening uptake among women in Ghana. By identifying and analyzing key barriers and facilitators, the review seeks to inform evidence-based policy, guide targeted interventions, and support improved screening practices tailored to the Ghanaian context. These efforts are vital to improving screening coverage and reducing preventable cervical cancer deaths in Ghana.